Marketing Standards and Restrictions Clause Samples

Marketing Standards and Restrictions. In its Marketing, the MCO must establish and maintain a system for confirming that enrolled Recipients have in fact enrolled in the MCO and understand the rules applicable under the plan, and have made an Informed Choice to enroll. The MCO may distribute brochures and display posters at physician offices and clinics, informing patients that the clinic or physician is part of the MCO’s Provider network. The MCO may provide health education materials for Enrollees in Providers’ offices. The MCO, its agents and Marketing representatives shall not: 3.15.1 Offer or grant any reward, favor, compensation or provide for cash or any other monetary rebate, as an inducement to a Recipient or a SNBC Enrollee to enroll or remain enrolled in the MCO. This restriction does not prohibit the MCO from explaining any legitimate benefits a Recipient might obtain as an Enrollee of the MCO, or from offering incentives to Enrollees for taking part in preventive health care services, medical management incentive programs, or activities designed to improve the health of MCO Enrollees. The MCO shall not seek to influence a Recipient’s enrollment with the MCO in conjunction with the sale of any private insurance. 3.15.2 Engage in any discriminatory activities. 3.15.3 Offer or grant any reward, favor or compensation to a person, county or organization not directly hired or contracted by the MCO to conduct marketing, who in the process of informing potential Enrollees about Medical Assistance or other Medicare Programs, steers or attempts to steer the potential enrollee toward a specific plan or limited number of plans. 3.15.4 Engage in any activities that could mislead or confuse Recipients, or misrepresent the MCO. 3.15.5 Make any written or oral assertions or statements that a Recipient or Enrollee must enroll in the MCO in order to obtain or maintain Medical Assistance and Medicare covered benefits, or that the MCO is endorsed by CMS, Medicare, the STATE, or federal government. The MCO may explain that it is approved for participation in Medicare. 3.15.6 Conduct door-to-door solicitation to current or potential SNBC Enrollees. In addition, the MCO must comply with Medicaid regulations that do not allow direct or indirect telephone or other cold-call marketing activities to potential SNBC Enrollees.